TY - JOUR
T1 - Cigarette smoking in British men and selection for coronary artery bypass surgery
AU - Morris, Richard W.
AU - McCallum, Alison K.
AU - Walker, Mary
AU - Whincup, Peter H.
AU - Ebrahim, Shah
AU - Shaper, A. Gerald
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 1996/6/1
Y1 - 1996/6/1
N2 - Objective - To examine the relation between smoking status, clinical need, and likelihood of coronary artery bypass grafting in middle aged men. Design - A prospective study of cardiovascular disease in British men aged 40 to 59 years, screened in 1978-80 and followed until December 1991. Subjects and setting - 7735 men drawn from one general practice in each of 24 British towns. Main outcome measure - Coronary artery bypass graft surgery. Results - Of the 3185 current smokers, 38 (1.03/1000/year) underwent coronary artery bypass surgery compared with 47 of 2715 (1.45/1000/year) ex-smokers, and 19 of 1817 (0.85/1000/year) never-smokers. Ex-smokers had a lower incidence of major ischaemic heart disease during follow up than current smokers. After adjustment for incidence of ischaemic heart disease during follow up, the hazard ratio of coronary artery bypass surgery for ex-smokers compared with smokers was 1.52 (95% confidence interval 0.99 to 2.34). Ex-smokers were more likely at screening to recall a doctor diagnosis of ischaemic heart disease than smokers (7.1% v 5.3%), but among those who recalled a doctor diagnosis, smokers were less likely to undergo coronary artery bypass surgery than ex-smokers (9.4% v 3.5%, P = 0.026). By 1992, men defined as smokers at screening were no less likely than ex-smokers to have been referred to a cardiologist (18.5% v 18.8%), nor to report having undergone coronary angiography less frequently than ex-smokers (12.7% v 11.4%). Conclusion - Even allowing for the strong relation between coronary artery bypass surgery and clinical need, continuing smokers were less likely to undergo coronary artery bypass surgery than ex-smokers. A complex interplay exists between the men's experience of heart disease, the decision to stop smoking, and the willingness of doctors to consider coronary artery bypass surgery.
AB - Objective - To examine the relation between smoking status, clinical need, and likelihood of coronary artery bypass grafting in middle aged men. Design - A prospective study of cardiovascular disease in British men aged 40 to 59 years, screened in 1978-80 and followed until December 1991. Subjects and setting - 7735 men drawn from one general practice in each of 24 British towns. Main outcome measure - Coronary artery bypass graft surgery. Results - Of the 3185 current smokers, 38 (1.03/1000/year) underwent coronary artery bypass surgery compared with 47 of 2715 (1.45/1000/year) ex-smokers, and 19 of 1817 (0.85/1000/year) never-smokers. Ex-smokers had a lower incidence of major ischaemic heart disease during follow up than current smokers. After adjustment for incidence of ischaemic heart disease during follow up, the hazard ratio of coronary artery bypass surgery for ex-smokers compared with smokers was 1.52 (95% confidence interval 0.99 to 2.34). Ex-smokers were more likely at screening to recall a doctor diagnosis of ischaemic heart disease than smokers (7.1% v 5.3%), but among those who recalled a doctor diagnosis, smokers were less likely to undergo coronary artery bypass surgery than ex-smokers (9.4% v 3.5%, P = 0.026). By 1992, men defined as smokers at screening were no less likely than ex-smokers to have been referred to a cardiologist (18.5% v 18.8%), nor to report having undergone coronary angiography less frequently than ex-smokers (12.7% v 11.4%). Conclusion - Even allowing for the strong relation between coronary artery bypass surgery and clinical need, continuing smokers were less likely to undergo coronary artery bypass surgery than ex-smokers. A complex interplay exists between the men's experience of heart disease, the decision to stop smoking, and the willingness of doctors to consider coronary artery bypass surgery.
KW - Coronary artery bypass surgery
KW - Ischaemic heart disease
KW - Patient selection
KW - Smoking status
UR - http://www.scopus.com/inward/record.url?scp=0029944213&partnerID=8YFLogxK
U2 - 10.1136/hrt.75.6.557
DO - 10.1136/hrt.75.6.557
M3 - Article
C2 - 8697156
AN - SCOPUS:0029944213
SN - 1355-6037
VL - 75
SP - 557
EP - 562
JO - Heart
JF - Heart
IS - 6
ER -